In a country entrenched in conservatism and burdened by an inaccessible healthcare system, many Filipina trans women medically transition by their own efforts, even if it means enduring health complications, emotional strain, and financial hardship in the process.
A 2023 retrospective study conducted at a community-led clinic in Metro Manila between 2017 and 2019 found that nearly 60 percent of transgender individuals use hormone treatments that did not follow international medical guidelines. Among transfeminine participants, that figure rose to a staggering 86 percent. Most rely on birth control pills or other hormones sourced from peers or online markets, often without medical supervision. In fact, 94.5 percent of transfeminine individuals on gender-affirming hormones were doing so without a doctor’s prescription.
Unseen and unserved
These numbers reflect a larger systemic failure. In a country that falls behind in providing gender-affirming care, countless transitioning women resort to self-medication, regardless of whether they have received professional guidance or not. The majority of transitioning services have been provided by private institutions, where costs are often prohibitive. It was only in recent years that nongovernmental organizations such as LoveYourself and Trans Health Philippines started to offer more accessible support systems and medical consultations to help individuals receive appropriate prescriptions for hormone therapy.
In June 2024, the launch of clinics in Quezon City under the Strategic Trans* Health Access to Resources and Services Program marked another important step forward. However, the broader healthcare system has yet to institutionalize trans-inclusive care.
To date, no hormone treatments have been officially approved in the country for gender affirmation, nor has the Department of Health issued any national guidelines on gender-affirming hormonal therapy. There is also an overall disinterest in the medical curriculum, making it difficult to train more providers and reduce the costs of such services.
In an interview with ABS-CBN, LoveYourself founder Yanyan Araña acknowledged the difficulties in catering to the countless transgender people across the Philippines, being one of very few clinics that specialize in trans-focused care. “Iba’t iba ‘yung kaso, pero common talaga na struggle ‘yung pera kasi mahal ‘yung gastos, at nagmamahal dahil…hindi siya bahagi at hindi supportive ‘yung ating healthcare system sa ganitong proseso,” she said.
(There are multiple reasons, but money is a common struggle because of the high costs, and it becomes expensive because our healthcare system is not supportive of these processes.)
LoveYourself currently operates 10 clinics across the Philippines, some in partnership with organizations like Hi-Precision Diagnostics and Mediprime. But the overwhelming demand far outnumbers the limited practicing medical professionals. As a result, the free services come with a cost of long waitlists, making self-medication, despite its risks, a more accessible and appealing alternative for many.
Dolls and black markets
For Koume Tokura (II, BS BIO-MBB), the memory of her going through self-medicated gender-affirming hormone therapy (GAHT) for the first time remains vivid. “It was a few weeks before my 18th birthday. I still remember the exact date: March 22, 2023,” she tells The LaSallian.
She had been pondering going on GAHT long before she turned 18. Although some gender health clinics in the Philippines cater to medically transitioning individuals as young as 16, Tokura did not have the support of her parents to go through with it.
“When you’re a minor, you wouldn’t actually have access to gender-affirming healthcare if you don’t have the support of your parents. And… well, I didn’t. So… I just thought my only choice was to…take matters into my own hands,” she says.
Thus, Tokura resorted to the internet. She scoured online until she found a trans YouTuber who was offering advice for individuals who were self-medicating. The content creator also had a Shopee account that sold several GAHT products—items that are generally not available without a prescription.
Despite knowing the risks, Tokura purchased her first “combo” of Estrofem and Androcur from that Shopee account. Combo is a term used by Filipina trans women to describe their self-prescribed GAHT regimen.
But GAHT products come at a steep cost. Since Tokura had to hide the fact that she was self-medicating from her parents, she had to spend around P1,500 to P3,100 every month without any kind of financial support. When she could no longer afford the pills usually prescribed for GAHT, Tokura started experimenting with Diane 35, a cheaper, contraceptive pill used by cisgendered women that is also used by trans women due to its combination of estrogen and anti-androgen properties.
When asked about the challenges she faced, Koume recalls, “It was expensive. I wasn’t out to my family yet, so I had to order stuff with their money,” emphasizing the emotional and financial strain that accompanied her self-medication journey. “I had to hide the medicine in my bags and bring it to school every day so they wouldn’t figure it out,” she adds.
For most Filipina trans women like Tokura, the burden of medically transitioning is something they bear alone. Amid the social stigma, health risks, and financial problems, Tokura still had the strength to carry on—until her former friends outed her, and her parents stepped in to stop her from continuing the treatment.
Uncharted paths
Despite the setbacks, Tokura remains resolute. “When I finally get a stable income, I’m planning on going to a professional and getting myself proper care,” she declares, hoping to one day consult a licensed endocrinologist, something she couldn’t afford at the time.
Given these hurdles, Tokura strongly discourages self-medicating: “It’s risky. It’s better to have a doctor know the dose that you need.” She warns, “You might be throwing your money at self-medication and nothing’s actually happening because you’re not actually taking enough or you’re taking too much.”
A 2019 narrative review by a group of endocrinologists found that unsupervised hormone replacement medication increases the risks of blood clots and cardiovascular conditions, among other fatal diseases. Tokura admits that medical supervision could have addressed many of the uncertainties she encountered while self-medicating. “I would actually have a prescription for it, and I wouldn’t have to order it from sketchy online shops,” she said. Having professional guidance, she reflected, would have helped her understand the correct dosage and prepare for the effects on her body.
Tokura’s case underscores a concern shared by many in the trans community: the urgent need for accessible gender-affirming healthcare. As their struggles persist, advocates like Araña continue to call for systemic support: “It would be better na ma-institutionalize ang [trans health care] on a national level in order for it to be more accessible and affordable as well.”
This article was published in The LaSallian‘s June 2025 issue. To read more, visit bit.ly/TLSJune2025.
